In a new rulemaking proposal on December 6, 2022, CMS proposed to broadly require electronic versions of prior authorization by 2026. The proposal will impact ACA Exchange Plans, Managed Medicaid, and Medicare Advantage.
That makes the regulatory proposal much broader than 2022's Hill proposal, the "Improving Seniors' Access to Care Act," which pointed to Medicare Advantage plans (FN1). Reducing the burdens of prior authorization has been an AMA priority, and also heavily impacts some diagnostic tests, including imaging and genomics.
For a 2019 review of Lab Benefit Managers by Phillips and Deverka, here. A 2020 6-page white paper on LBM by Kentmore consultancy, here. A 2022 article comparing PBM and LBM, here. Articles on radiology benefit management, RBM, go back 15 years or more (e.g. here).
- On the new HHS Prior Auth proposal, trade journal article in Fierce Healthcare here.
- And Healthcare Finance here.
- And Health Payor Intelligence here.
- Healthcare Dive here. Update with more interviews, here.
- Find a 403-page pre publication document at Federal Register here.
- The typeset version will publish December 13.
- CMS also issued a lengthy fact sheet summarizing the proposed rule - here.
|December 6, 2022|
Also of possible interests to labs and imaging centers, the rules propose to facilitate (within Medicare) exchange of information between ordering providers and rendering providers/suppliers.